Week 10: Parkinson's disease drugs

Question 1

Parts of extrapyramidal system? 3

The Extrapyramidal system is responsible for?

Motor symptoms of Parkinson’s disease?
(TRAP)

Answer 1

1. Basal ganglia
2. Substantia nigra
3. Dopamine neurons

Involuntary muscle movement

Tremor
Rigidity
Akinesia/Bradykinesia
Postural Instability

Question 2

Why not give L-DOPA by itself?

causes what if given by itself?

Answer 2

Cannot cross the BBB

Causes EMESIS!!!!!

Question 3

What is the gold standard to treat Parkinson’s disease?

Also given for?

Answer 3

LevoDOPA
Carbidopa

Pack the CAR drives L-DOPA up the BBB. It’s the bodyguard

Also given for Restless Leg Syndrome

Question 4

ADVERSE EFFECTS of increasing Dopamine in the periphery and centrally?

BINGO is for all parkinsons drugs that increase dopamine

Answer 4

BEHAVIOR ABNORMALITIES
IMPULSE CONTROL DISORDERS (20%)
NARCOLEPSY/SOMNOLENCE
GI SYMPTOMS
ORTHOSTATIC HYPOTENSION

BEHAVIOR ABNORMALITIES
-Hallucinations, other changes

IMPULSE CONTROL DISORDERS (20%)
-Gambling, hypersexuality, more. NOTE: Screening Tools Available
-Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP)

NARCOLEPSY/SOMNOLENCE
-Daytime drowsiness

GI SYMPTOMS
-Even though we have Sinemet® and Stalevo®, this is still a major A/E
-Constipation- although this is common with the DISEASE PROCESS

ORTHOSTATIC HYPOTENSION
-This mechanism isn’t 100% known, but dopamine may disrupt baroreceptor

Question 5

ADVERSE EFFECTS/CONTRA-INDICATIONS:

Specific to L-Dopa & protectors

Can cause what?
What can be added to reduce?
L-dopa is associated with what?
may cause?
Avoid what kind of diet?
Take with what?

Answer 5

DYSKINESIAS
- ironically Levodopa can cause movement disorders
-Amantadine can be added to reduce/manage

L-Dopa is associated with MELANOMA!!!!!!

May cause harmless discoloration of urine and sweat

Avoid High protein diet >2
Take with carbs

Question 6

Entacapone and Tolcapone?
(El capone)

What is it?
Boxed warning for?
What can it cause?
must be given with?

Answer 6

Bodyguard # 2” to L-DOPA

HEPATOTOXICITY!!!!

orange/ brown urine discoloration

Must be given with L-DOPA

Question 7

MAO-B Inhibitors (help with dopamine)

Selegiline, Rasagiline

cause what syndrome?
symptoms?
“SHIVERS”

MAO-B increase what?

Answer 7

Seratonin syndrome

Shivering
Hyperreflexia
Increased temp
Vital signs
Encephalopathy
Restlessness
Sweating

Dopamine

Question 8

DOPAMINE AGONISTS (Non-ergot)

Ropinirole, Pramipexole, Apomorphine

ADVERSE EFFECTS?**

Answer 8

BINGO!

“SLEEP ATTACKS”,
caution with driving

Question 9

MAOIs can cause hypertensive crisis

Avoid what kind of food when on MAOI?

What are the foods?

Answer 9

Avoid food or beverage high in Tyramine

Cheese
Alcohol- Beer and Wine
Cured/Aged/smoked meats (salami, pepperoni, fish, etc.)
fermented foods (sauerkraut, kimchi)
Fava beans
Avocado
Caffeine

Question 10

Avoid what while taking an MAOI?

wait how long before starting another drug?

Answer 10

AVOID ALL HERBALS/MEDICATIONS UNLESS APPROVED BY PROVIDER WHILE TAKING AN MAO-I

Anything SYMPATHETIC (adrenergic)

2 weeks

Question 11

CENTRALLY ACTING ANTICHOLINERGICS (block acetylcholine)

Benztropine and Trihexyphenidyl

used to treat?
adverse effects?

Answer 11

Parkinsonism

Drug Induced Extrapyramidal Symptoms (Commonly given with antipsychotics)

**CNS Sedation
**Tachycardia

Question 12

Treats Parkinson disease

BenzTROPINE & Trihexyphenidyl

ADVERSE EFFECTS?

Answer 12

Can’t see
Can’t pee
Can’t spit
Can’t shit
Can’t schvitz

CNS Sedation, Tachycardia

Question 13

Benztropine and Trihexyphenidyl

contraindications

Answer 13

Glaucoma
BPH
GI obstruction

Question 14

ANTI-PARKINSON/ ANTIVIRAL

Amantadine

Used for?
Unique side effect?**
Other side affects?

Answer 14

Used for Drug Induced Parkinsonism

Livedo Reticularis (1-6% of patients)
blue net like pattern***

Can’t see, can’t pee, can’t spit, can’t shit, can’t schvitz

BINGO